Opinion

Proposed Screening Recommendations Limit Access to Mammography

As a physician, one of the hardest moments to watch and experience alongside a patient is a diagnosis of breast cancer. And, perhaps most frustrating is witnessing an advanced stage diagnosis that could have been detected at an earlier, more treatable stage. These diagnoses are all too common among women in their forties, and yet a task force in Washington has published draft recommendations stating women in this age group do not need annual mammograms, and that women 50-74 only need an exam every other year. The guidelines must be changed.

If adopted, the recommendations, issued by the United States Preventive Services Task Force, could limit access to mammograms for 22 million American women between the ages of 40-49, including approximately 2.8 million African Americans who have the highest rate of mortality from breast cancer. By assigning a “C grade”, insurance companies will no longer be required to offer screenings without additional costs for women ages 40-49. Cancers could go undetected or be caught at a later stage when mortality rates are higher and more invasive treatments are needed.

How many cancers is it ok to miss? That’s why 29 breast center leaders and survivors are descending on Capitol Hill tomorrow to make our voices heard. In our experience, if we can’t find it, we can’t treat it.

While well intended, the USPSTF is an advisory group of volunteers, none of whom are experts in the area of breast cancer such as radiologists, breast cancer surgeons or oncologists. Their recommendations are inconsistent with guidelines from leading clinical experts, such as the American Cancer Society and American College of Obstetrics and Gynecology, who continue to recommend annual mammograms for women over 40. We have enough challenges getting women to make their mammogram appointment and guideline uncertainty doesn’t help. It only creates confusion for providers and patients.

We’ve been here before. In 2009, the USPSTF drastically changed the breast cancer screening recommendation for women, issuing guidance that breast cancer screening was not necessary for women ages 40-49. This action resulted in a national outcry. HHS Secretary Kathleen Sebelius eventually weighed in to assure women that federal policy would not change.

However this year the Task Force weighed in on more than just when to get screened, stating the evidence was insufficient for a 3D mammogram exam. This couldn’t be further from the truth – both from our experience in clinical practice and in the data. The Task Force dismissed hundreds of peer-reviewed publications that clearly and consistently show 3D mammography significantly increasing detection of invasive cancer while reducing false positive recall rates – both of which are key concerns about traditional mammograms raised by the Task Force.

Screening is the critical first step towards helping women survive fast growing cancers and it is critical that women be screened annually without financial barriers beginning at age 40. Along with patients, professional groups, trade associations, non-profits and others in the breast cancer community, we urge Congress to place a two-year moratorium on finalizing the recommendations until all concerns, including those raised here, have been studied.

The simple fact is breast cancer cannot be treated if it cannot be found. We’ve lost far too many women in the prime of their lives to lose further ground to this devastating disease.

Dr. Ricki Pollycove is Founding Director for Education for California Pacific Medical Center’s Breast Health Center in San Francisco and Board Member of the National Consortium of Breast Centers  

Dr. Jacki Sweeney is Medical Director of the St. Elizabeth Breast Centers, Edgewood, KY

Dr. Michael Alpern is a radiologist with HonorHealth Breast Health and Research Center in Phoenix, AZ

Dr. Dona Hobart is the Medical Director for the Center for Breast Health at Carroll Hospital Center in Westminster, MD

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